1 / 24

DaSH

Benefits of Adult Day Services for Caregivers: Effective, Sustainable and Affordable Steven H. Zarit, Ph.D. Penn State University LTSS Policy Summit October 1, 2014 Szarit @psu.edu. DaSH. Daily Stress and Health Study. Acknowledgements.

melvin-franks
Download Presentation

DaSH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Benefits of Adult Day Services for Caregivers: Effective, Sustainable and Affordable Steven H. Zarit, Ph.D. Penn State University LTSS Policy Summit October 1, 2014 Szarit @psu.edu DaSH Daily Stress and Health Study

  2. Acknowledgements • Support for this research was provided by the following grants: • National Institute on Aging, grant RO1 AG031758, “Daily Stress, Health and Well-being of Family Caregivers • National Institute on Aging, grant RO 1 AG11354, “Stress Reduction for Caregivers of Persons with Dementia” • National Institute of Mental Health, grant RO1 MH59027, “Reducing Behavior Problems in Dementia: Day Care Use”

  3. Benefits of Adult Day Services for Family Caregivers Overview • The challenges facing family caregivers • Respite as a strategy for lowering stress • Daily Stress and Health Study: Protecting the health and well-being of caregivers • Conclusions and questions

  4. The Costs of Caregiving • Increased subjective stress • Increased emotional distress • Increased health problems • Increased mortality

  5. Respite as a Strategy for Lowering Caregiving Stress • Respite provided by family • Paid respite • Adult Day Services • In-home respite • Overnight or short-term institutional respite

  6. The Daily Stress and Health of Caregivers (DaSH) Study Caregivers are exposed to care-related stressors about 140 min./day Emotions (depression, anger, positive feelings) STRESS HORMONES: CORTISOL, DHEA-S DAILY STRESSORS Health ADS Use lowers daily stress exposure by 43%

  7. How We Conducted the DaSH Study Day1 Day3 Day2 Day5 Day7 Day8 Day2 Day2 DAY 1 2 3 4 5 6 7 8 • 5 saliva samples each day • Phone interviews for • 8 consecutive days • Some of the days caregivers used ADS • Some of the days they did not use ADS (non-ADS days) • Measures: Daily stressors; daily affect • Before getting out of bed •  30 min after getting out of bed •  Before lunch •  Afternoon (~ time when relative returns from ADS) •  Bedtime

  8. Participant Saliva Collection Kit

  9. Cortisol as a Precursor of Illness • Short-term activation (i.e., cortisol elevation) is adaptive • Repeated or prolonged activation (e.g., caregiving) leads to dysregulation of cortisol • a. Cortisol overproduction • b. Blunted diurnal salivary cortisol rhythm • c. Cortisol dysregulation is associated with depression, problems with learning & memory, inadequate immune system activation; chronic health problems

  10. DHEA-S as a Precursor of Illness • DHEA-S is a hormone that protects the body from damaging effects of cortisol • More DHEA-S is better • Chronic stress attenuates the DHEA-S response • Positive benefits of DHEA-S • Increases positive emotions and decreases depression • Lowers risk of cardiovascular disease • May protect against damage of brain neurons leading to Alzheimer's disease • Lowers risk of mortality

  11. DHEA-S • Dehydroepiandrosterone-Sulfate

  12. DESCRIPTION OF PARTICIPANTSn = 173

  13. The Daily Stress and Health of Caregivers (DaSH) Study Caregivers are exposed to care-related stressors about 140 min./day Emotions (depression, anger, positive feelings) STRESS HORMONES: CORTISOL, DHEA-S DAILY STRESSORS Health ADS Use lowers daily stress exposure by 43%

  14. Normal diurnal cortisol pattern Average Cortisol (nmol/L)

  15. Cortisol on ADS and non-ADS days: Low morning rise

  16. Cortisol on ADS and non-ADS days: Medium low morning rise

  17. Effects of ADS Use on DHEA-S • No same day effects of ADS • Lagged effects: DHEA-S was higher on days following ADS use • Levels of DHEA-S covaried significantly with positive emotion

  18. Daily DHEA-S andPositive Affect Example: Participant 1134

  19. The Daily Stress and Health of Caregivers (DaSH) Study Caregivers are exposed to care-related stressors about 140 min./day Emotions (depression, anger, positive feelings) STRESS HORMONES: CORTISOL, DHEA-S DAILY STRESSORS Health ADS Use lowers daily stress exposure by 43%

  20. Implications of DASH • Each day of adult day care use results in improved levels of key stress hormones for carergivers • These improvements reduce the risk of illness for caregivers • Improvements in emotional responses also have implications for long-term health • Caregivers who used more ADS days at the initial study period had better functional health

  21. The Potential Role of ADS and Other Forms of Respite in Lowering Burden • Sustainable help • Affordable • Effective

  22. Limitations of Adult Day Service Programs • Limited ability to serve small towns and rural areas • Unwillingness of the person with dementia to attend • Reluctance of caregivers to use respite services • Not covered by Medicare

  23. Investigative Team • Mary Jon Barrineau • Amanda Leggett • Yin Lieu • Allison Reamy Steven Zarit David Almeida Elia Femia Laura Klein • Peter Molenaar • Michael Rovine • Kyungmin Kim • Courtney Whetzel

  24. Summary and Questions • ADS use relieves caregivers’ exposure to stressors • ADS use improves caregivers’ levels of stress hormones, which reduces risk of illness • ADS use leads to improved emotional well-being of caregivers For more information or copies of DaSH publications, contact • Dr. Steven Zarit • szarit@psu.edu

More Related